Efectividad Del Foto-Test Frente Al Mmse, Para El Cribado Del Deterioro Cognitivo En Población Peruana / Effectiveness Of The Photo-Test Front Of The Mmse, For The Screening Of Cognitive Deterioration In Peruvian Population

Resumen El progresivo incremento de la enfermedad de Alzheimer ha generado el interés en su detección temprana, siendo los test de cribado cognitivo una herramienta útil, sin embargo, se necesita que los mismos estén culturalmente adaptados, sean objetivos y confiables. En el Perú, esta necesidad es mayor ya que el nivel educativo de la población de la tercera edad es mayoritariamente bajo. La presente investigación tiene como objetivo conocer la sensibilidad y especificidad del FOTOTEST frente al MMSE para el cribado/detección de deterioro cognitivo, analizando la relación de estos test cognitivos frente a uno de actividad funcional. Se evaluaron a 107 adultos mayores, con un rango de edad entre 60 y 89 años. Se utilizó la escala de Yesavage para la depresión geriátrica, el cuestionario de actividades funcionales de Pfeffer, MMSE y FOTOTEST. El análisis efectuado a través de la prueba de Pearson, evidencia una correlación significativa positiva entre el MMSE/FOTOTEST (Pearson 0.386, p<0.003), mientras que solo el MMSE mostró una correlación significativa negativa con el PFAQ (Pearson -0.320, p<0.013). Sin embargo, el FOTOTEST no mostró una correlación significativa con el PFAQ (Pearson -0.067, p<0.613). Adicionalmente, se calcula el porcentaje de efectividad y especificidad estimada para el FOTOTEST siendo de 100.00% y 92.68% respectivamente, superior al del MMSE, cuyo porcentaje estimado de efectividad fue de 83.33%, y especificidad 34.14%. Se concluye que el FOTOTEST sería una prueba más útil para la detección del deterioro cognitivo.

Abstract The progressive increase of Alzheimer's disease has generated interest in its early detection with cognitive screening tests being a useful tool, however, they need to be culturally adapted, objective and reliable. In Peru, this need is greater since the educational level of the elderly population is mostly low. The aim of the present study is to know the estimate sensitivity and specificity of FOTOTEST against MMSE for the screening/detection of cognitive impairment, analyzing the relationship of these cognitive tests with one of functional activity. 107 elderly people, aged 60-89 years, were evaluated. The Yesavage scale for geriatric depression was used, the functional activities questionnaire of Pfeffer, MMSE, and FOTOTEST. Pearson's analysis showed a significant positive correlation between MMSE/FOTOTEST (Pearson 0.386, p <0.003), whereas only MMSE showed a significant negative correlation with PFAQ (Pearson -0.320, p <0.013). However, FOTOTEST did not show a significant correlation with PFAQ (Pearson -0.067, p <0.613). In addition, the percentage of effectiveness and specificity estimated for FOTOTEST was 100.00% and 92.68%, respectively, higher than the MMSE, with an estimated percentage of effectiveness being 83.33%, and specificity of 34.14%. We conclude that FOTOTEST would be a more useful test for the detection of cognitive impairment than MMSE

Narrow-band ultraviolet B phototherapy regimens for the treatment of chronic actinic dermatitis and analysis of factors influencing treatment compliance / 中华皮肤科杂志

Objective To investigate the optimal regimen of narrow-band ultraviolet B (NB-UVB) phototherapy in the treatment of chronic actinic dermatitis (CAD),and to analyze factors influencing treatment compliance.Methods Demographic data,results of photobiological tests,treatment parameters and clinical responses were collected from CAD patients who received NB-UVB phototherapy in Huashan Hospital affiliated to Fudan University from January 2008 to June 2015,and were reviewed retrospectively.Statistical analysis was done by using two independent samples t-test and chi-square test with SAS9.3 software to compare the clinical data between patients who completed and did not complete the NB-UVB phototherapy.Results A total of 79 CAD patients with Fitzpatrick skin type Ⅳ received NB-UVB phototherapy.Of these patients,61 (77％) completed the whole treatment,while 18 (23％) dropped out because of intolerance to the NB-UVB radiation.Among the 61 patients who completed the treatment,the average initial,final and cumulative radiation doses of NB-UVB were (0.08 ± 0.01) J/cm2,(0.32 ± 0.08) J/cm2and (5.9 ± 2.5) J respectively,and patients received (28 ± 8) times of treatment in average.When the radiation dose went up to 0.30 J/cm2,most skin lesions were cleared in 52 (85％) patients.A total of 19patients received phototesting again after the end of phototherapy.Among 16 patients sensitive to ultraviolet A (UVA) before the treatment,6 had normal minimal erythema dose to UVA (UVA-MED),and another 6 had improved UVA-MED after the treatment.Among 16 patients sensitive to UVB before the treatment,11 got normal UVB-MED and another 3 had improved UVB-MED after the treatment.Univariate analysis showed no significant differences in gender,age,duration of the disease,sensitivity to UVA and UVB radiation,results of photopatch test and patch test between the patients who completed and did not complete the treatment (all P ＞ 0.05).Conclusions The appropriate NB-UVB phototherapy for CAD patients should start at an initial radiation dose of 0.08 J/cm2 in spring and end at a final radiation dose of 0.30 J/cm2 for about 28 sessions,which can effectively reduce the photosensitivity to both UVA and UVB in CAD patients.Additionally,NB-UVB phototherapy can be applied in CAD patients of different gender,age,disease duration and photosensitive condition.

Phototest for neurocognitive screening in multiple sclerosis / O Fototest no rastreio neurocognitivo na Esclerose Múltipla

Multiple Sclerosis (MS) is one of the most common neurological disorders. Cognitive dysfunction is considered a clinical marker of MS, where approximately half of patients with MS have cognitive impairment. Objective : The Phototest (PT) is a brief cognitive test with high diagnostic sensitivity, accuracy and cost-effectiveness for detecting cognitive deterioration. Our aim was to test the utility of the PT as a neurocognitive screening instrument for MS. Methods : The study enrolled 30 patients with different types of MS from an outpatient clinic as well as 19 healthy participants. In conjunction with the PT, the Montreal Cognitive Assessment (MoCA), Barthel Index (BI), Expanded Disability Status Scale (EDSS), and Fatigue Severity Scale (FSS) were administered. Results : The MS group obtained significantly lower results on all domains of the PT, except for the naming task. The PT showed good concurrent validity with the MoCA. In direct comparison to the MoCA, PT showed a greater area under the curve and higher levels of sensitivity and specificity for MS neurocognitive impairments. A cut-off score of 31 on the Phototest was associated with sensitivity of 100% and specificity of 76.7%. Conclusion : The PT is a valid, specific, sensitive and brief test that is not dependent on motor functions. The instrument could be an option for neurocognitive screening in MS, especially in identifying cases for further neuropsychological assessment and intervention.

A Esclerose Múltipla (EM) é das doenças neurológicas mais comuns. A disfunção cognitiva consiste num marcador clínico da EM, cerca de metade dos pacientes apresentam comprometimento cognitivo. Objetivo : O Fototest (FT) é um teste breve, sensível, específico e com boa relação custo-eficácia na deteção de deterioração cognitiva. Pretendemos testar a validade do FT como um instrumento de screening neurocognitivo na EM. Métodos : O estudo envolveu uma amostra de 30 doentes com diferentes tipos de EM de uma clínica de tratamento ambulatório e 19 participantes saudáveis. Em conjunto com o FT, foram aplicados o Montreal Cognitive Assessment (MoCA), o Índice de Barthel (IB), a Expanded Disability Status Scale (EDSS) e a Escala de Severidade de Fadiga (FSS). Resultados : O grupo EM obteve resultados significativamente inferiores em todos os domínios do FT, excepto na tarefa de nomeação. O FT apresenta boa validade concorrente com o MoCa. Na comparação direta com o MoCa, o FT revelou uma área sob a curva superior e níveis de sensibilidade e especificidade para os défices cognitivos na EM superiores. Ao ponto de corte de 31 no FT correspondem valores de sensibilidade de 100% e especificidade de 76,7%. Conclusão : O FT é um teste válido, específico, sensível e breve, não dependente das funções motoras. Pode ser uma opção para o screening neurocognitivo na EM, especialmente na identificação de casos para posterior avaliação neuropsicológica e intervenção.

A systematic review and meta-analysis of the diagnostic accuracy of the Phototest for cognitive impairment and dementia / Revisão sistemática e meta-análise da acurácia diagnóstica do Phototest em comprometimento cognitivo e demência

The recently developed Phototest is a simple, easy and very brief test for detecting cognitive impairment or dementia. OBJECTIVE: To evaluate the diagnostic accuracy of the Phototest for detecting cognitive impairment or dementia. METHODS: We used a manually created database to search for studies evaluating the Phototest diagnostic yield and performed an initial meta-analysis to determine sensitivity (Sn) and specificity (Sp) of diagnostic parameters. We also performed a second meta-analysis of individual participant data. RESULTS: In total, 6 studies were included in the meta-analysis. For dementia, Sn was 0.85 (95% CI, 0.82-0.88) and Sp 0.87 (95% CI, 0.85-0.99); for cognitive impairment, Sn was 0.80 (95% CI, 0.77-0.92) and Sp 0.88 (95% CI, 0.86-0.90). In the individual data meta-analysis, 1565 subjects were included, where best cut-off points for dementia and for cognitive impairment were 26/27 (Sn=0.89 (95% CI 0.85-0.91), Sp=0.84 (95% CI, 0.82-0.91)) and 28/29 (Sn=0.79 (95% CI, 0.76-0.81), Sp=0.88 (95% CI, 0.86-0.90)), respectively. CONCLUSION: Phototest has good diagnostic accuracy for dementia and cognitive impairment. It is brief, simple and can be used in illiterate persons. This makes it suitable for use in primary care settings and/or in subjects with low educational level.

Phototest é um teste simples, fácil e muito rápido para detecção de comprometimento cognitivo e demência recentemente desenvolvido. OBJETIVO: Avaliar a acurácia diagnostica do Phototest para detecção de comprometimento cognitivo e demência. MÉTODOS: Nós usamos um banco de dados manualmente criado para estudos que avaliassem a capacidade diagnóstica do Phototest e realizamos uma meta-análise para determinar a sensibilidade (Sn) e especificidade (Ep) dos parâmetros diagnósticos. Nós também realizamos uma segunda meta-análise dos dados individuais dos participantes. RESULTADOS: Um total de seis estudos foram incluídos na meta-análise. Para demência a Sn foi 0.85 (95% CI, 0,82-0,88) e Ep 0,87 (95% CI, 0,85-0,99); para comprometimento cognitivo a Sn foi 0,80 (95% CI, 0,77-0,92) e Sp 0,88 (95% CI, 0,86-0,90). Na meta-análise de dados individuais, 1565 foram incluídos, os melhores escores de corte para demência e para comprometimento cognitivo foram 26/27 (Sn=0,89 (95% CI 0,85-0,91), Ep=0,84 (95% CI, 0,82-0,91)) e 28/29 (Sn=0,79 (95% CI, 0,76-0,81), Ep=0,88 (95% CI, 0,86-0,90)), respectivamente. CONCLUSÃO: Photest tem boa acurácia diagnostica para demência e comprometimento cognitivo. É breve, simples e pode ser usado em pessoas analfabetas. Tornando-o apropriado para o uso em cuidados primários e/ou sujeitos com baixo nível educacional.

Clinical characteristics of adult-onset actinic prurigo in Asians: A case series.

Background: Actinic prurigo (AP) is a chronic, pruritic skin condition caused by an abnormal reaction to sunlight. Aims: The aim of this study is to determine the clinical characteristics of AP in patients attending the National Skin Centre, Singapore, from 1st January 1999 to 30th June 2008. Methods: Cases of AP diagnosed from 1st January 1999 to 30th June 2008 were retrieved from the center’s electronic medical records and analyzed. Results: A total of 11 patients were diagnosed with AP. The mean age at diagnosis was 52 years. There were 9 (82%) Chinese and 2 (18%) Malay patients. Nine (82%) were male and 2 (18%) were female. The most commonly affected areas were the face, forearms, and hands (72%). Phototesting showed reduced minimal erythema dose (MED) to ultraviolet A (UVA) in 5 (46%) patients, both UVA and ultraviolet B (UVB) in 4 (36%) patients and UVB in 1 (9%) patient. Seven (64%) patients reported partial improvement after treatment with a combination of topical corticosteroids and sunscreens. Four (36%) patients received systemic therapy with partial response. Conclusion: Adult-onset AP is more common in the Asian population, with a male predominance. The face, forearms, and hands are the most commonly affected areas. The absence of mucosal involvement is also a distinguishing feature between the Asian and Caucasian population. Close to half of the patients have reduced MED to UVA on phototesting. The prognosis for AP is poor as it tends to run a chronic course with suboptimal response to treatment.

Review of idiopathic photodermatitis at dermatology tertiary centre, Hospital Kuala Lumpur

Introduction: Photodermatitis had become more common reason for referral to dermatology clinics. In Southeast Asia, research regarding idiopathic photodermatitis is not well established. Photo and photo-patch tests are commonly used diagnostic investigations to support this diagnosis. Objective: To describe the epidemiological and clinical features of idiopathic photodermatitis referred for photo and photo-patch tests. Methods: This retrospective study reviewed the clinical data of patients with idiopathic photodermatitis who were referred for photo and photo-patch tests from January 2009 to July 2011. Patients’ demographics, spectrum of clinical presentations, results of photo and photo-patch tests and clinical outcome were reviewed. Results: 38 patients were included in the analysis. Majority of patients were males. The mean age was 47.2 years. 55.3% were Malays, 26.3% Chinese and 18.4% Indians. Most patients have Fitzpatrick’s skin type IV. The commonest clinical presentations were polymorphic eruptions consisted of erythematous patches, papules and eczema at the sun-exposed areas. On average, the patients have had the cutaneous eruption for more than 1 year prior to the initial clinic visit. 32 patients had photo test and 6 had photo and photo-patch tests. 56.3% had positive photo test and the lowest MED is 50mJ/cm2 in skin type IV. 20% had positive photo and photo-patch tests. Patients were treated with potent topical corticosteroid, physical sunblock and oral antihistamines which managed to control the disease severity. Conclusion: Most patients with idiopathic photodermatitis referred for photo test were middle-aged Malay males with skin type IV. The commonest cutaneous presentations were polymorphic eruptions at the sun exposed sites.

A Case of Hydroa Vacciniforme

Hydroa vacciniforme (HV) is a rare and chronic pediatric disorder that is characterized by photosensitivity and recurrent vesicles that heal with vacciniforme scarring. The pathogenesis of HV is unknown; no chromosome abnormality has been identified. HV patients have no abnormal laboratory results, so the diagnosis of HV is based on identifying the associated histological findings in a biopsy specimen and using repetitive ultraviolet phototesting to reproduce the characteristic vesicles on a patient's skin. Herein, we present a case of HV in a 7-year-old female who was diagnosed with HV according to histopathology and ultraviolet phototesting.

Artificial Reproduction of Lupus Erythematosus by Provocative Phototesting

Sunlight is one of the well-established factors which play key roles in the induction and exacerbation of lupus erythematosus. In two patients of discoid lupus erythematosus, we have experimentally reproduced skin lesions by provocative phototesting. Both UVA (100 joules/cm²) and UVB (80 millijoules/cm²) radiation induced the skin lesions. The reproduced skin lesions were clinically and histopathologically consistent with lupus erythematosus.

A case of hydroa vacciniforme with ocular involvment / 대한피부과학회지

Hydroa Vacciniforme is a rare, chronic, photosensitivity disorder witli onset in childhood that is characterized by recurrent, discrete vesiculation, necrosis and vacciniform scarring limited to sun exposed skin. We report a case of hydroa vacciniforme associated with ocular inwlvment in which vesicles could be induced only with single MED exposure to UVA.

Hydroa Vacciniforme

Hydroa vacciniforme is a very rare photosensitivity disorder. The primary skin lesion is a vesicle or bulla which then heals with vacciniform scarring. We report a case of hydroa vacciniforme recurred after 3 years period of quiescence in a 20 year-old man who had had history of the disease from the age of two. The duplication of the natural lesion, clinically and histologically, was successfully made by artificial UV-A irradiation on the patient's back.

A Case of Polymorphous Light Eruption Confirmed by Phototest / 대한피부과학회지

Polymorphous light eruption(PMLE) is an idiopathic, scquired syndrome characterized by a delayed abnormal response to light and a varied morphology of recurrent erythema, papules, vesicles or plaques on light-exposed areas of skin. We report herein s 42-year-old male patient who was clinically and histologically compatible with PMLE. To confirm the diagnosis, the phototest was performed by 50,J/crn of UVA, 5MED-UVB and visible light irradiation to the extensor surface of the forearm. Numerous erythematous papules developed at the (JVA-irradiated site. The histopathologic findings of the phototest induced lesion were compatible with PMLE. Therefore, our patient was confirmed as having PMLE with action spectrum in the IJVA range.

Two Cases of Type III Solar Urticaria / 대한피부과학회지

Solar urticaria is an uncommon disorder characterized by rapid development of urticarial reaction in areas of skin exposed to nonizing electromagnetic radiation. Herber and Baer classified solar urticaria into eight types on the basis of action spectrum and passive or reverse passive transfer ability. We report two cases of type ]g solar urticaria which were activated by visible light and negative in both passive and reverse passive transfer test.